IU researchers are making a difference

In the past six months, the world has battled a crisis that has consumed the nation and changed the way we live. But it is not the only crisis the U.S. faces. Before the COVID-19 pandemic upended our worlds, millions of Americans were battling the addictions crisis — and it hasn’t gone away. In some cases, it has gotten worse due to the pandemic.

IU researchers have remained strong in their efforts to combat an issue that impacted more than 20 million people in 2018 and that threatens even more due the pandemic.

"I am proud of the work we have done so far through IU’s Responding to the Addiction Crisis Grand Challenge," said Robin Newhouse, dean of the School of Nursing, distinguished professor and leader of the initiative. "As we mark National Recovery Month, we are reminded of the work that remains. Although our country is in the midst of one of the worst pandemics in decades, we must not forget the other crisis our country continues to face and the millions of people, and their families, who are dealing with a substance use issue."

Leading the way

The Responding to the Addictions Grand Challenge began in 2017 and includes 32 teams and more than 130 business, nonprofit, and government partners in 31 counties, who are addressing educational and training opportunities, prevention and treatment options, policy and law, and the economic impact of the addictions crisis.

Since the start of the pandemic, the Grand Challenge has trained hundreds of frontline workers and future workers in Indiana through various projects including the CARE Plus project, led by Debra Litzelman, senior research scientist at Regenstrief Institute and D. Craig Brater Professor of Global Health Education at the IU School of Medicine, and the Comprehensive Pain Assessment Clinic, led by Laura Romito, a professor at the IU School of Dentistry.

CARE Plus connects pregnant women and young mothers who have substance use issues to community health workers and other resources. There are 5 addiction recovery coaches and 10 community health workers who have enrolled 145 women in the program to date. The coaches, Litzelman said, have remained busy during the pandemic, pivoting their work to continue to provide services while maintaining safe social distancing.

"It has been a very challenging time, but the CARE work, coaching, and support is more needed now than even before COVID," Litzelman said. "Our participants, already challenged with housing, job, transportation, and food insecurities at baseline, are struggling more now. But our coaches have remained vigilant in helping the women and families they serve."

The Comprehensive Pain Assessment Clinic’s focus is to avoid the use of opioids whenever possible. Addressing not only pain symptoms but also their causes, the clinic brings together primary care physicians, physical therapists, occupational therapists, social workers, and marriage and family counselors to collaboratively address the needs of each patient. So far, the clinic has trained 34 students and helped 93 patients better manage pain. 

Additionally, Romito’s project has involved a review of curriculum and standards for future frontline workers in Indiana to make sure they are ready to work together to help patients prevent and overcome addiction. So far, approximately 1,400 health science, social work, and education students and faculty have worked together in opioid screening and to use a systems approach within and across professions and sectors.

"It's been very rewarding to see the enthusiasm of our students and faculty as they enhance their understanding of the complex problem of addiction and substance use through an interprofessional collaborative approach," Romito said. "The knowledge and skills they develop as a result of these experiences will enable them to be better prepared to help individuals, families, and communities dealing with substance use."

The Grand Challenge also has helped hundreds of Indiana teens involved in the criminal justice system get screened for substance use issues and referred to treatment through the Improving the Substance Use Care Cascade in the Juvenile Justice System project.

Led by Matt Aalsma, professor of pediatrics at the IU School of Medicine, the project has helped implement screenings at the time of a youth’s intake into the system and has trained 55 case managers to help offer referral and treatment options. 

The project initially was helping teens in Tippecanoe and Wayne County. However, it proved so successful that Aalsma was able to apply and receive a $4.8 million grant from the National Institute on Drug Abuse, which has allowed him to move into eight additional counties, some of which have very limited resources. Part of NIDA’s Justice Community Opioid Innovation Network, Aalsma’s project is the only one focused on juveniles.

"I'm really grateful to the Grand Challenges because it helped us create a pilot that then allowed us to create a bigger program," Aalsma said. "This really allows us to not only reach more youth, but to reach youth in counties that have little to no resources for this."

In addition to helping youth involved in the criminal justice system, another project led by Tamika Zapolski, associate professor in the Department of Psychology at IUPUI, has helped teens in Indiana who are at risk for using substances and developing substance use disorders.

Her project has enrolled more than 160 Indianapo-lis area students in school-based therapy called Going 4 Goals. The nine-week, in-school program teaches teens how to deal with strong emotions and manage stress.

Of those students enrolled in the program, 85 percent said the program affected their schooling in a positive way and almost all said it improved their communication with teachers and fellow classmates. Additionally, 55 percent of students said the program has positively affected their grades, teaching them valuable skills to help them focus in class and prioritize their academics.

Zapolski also has preliminary evidence on the efficacy of the intervention in decreasing substance use and risky health behaviors compared to students who were in the school’s health course. Of the teachers and school administrators interviewed about the program, 62 percent reported witnessing fewer behavior issues with students that participated in the group and 100 percent said that they would recommend Going for Goals to other schools.

Although Zapolski and her team is still running the program, due to COVID-19, they have moved it entirely online.

"We know that adolescence is a time when people start to experiment or engage in substance use," said Zapolski. "We also know that the earlier someone starts to use substances, even if it's experimental, it increases their risk for continuation of substance use. So, early intervention is key and this program has shown that this type of program works."

Additionally, the Grand Challenge has helped connect frontline workers with experts across Indiana through the launch of eight ECHO projects, including hubs around Integrated Pain Management, Indiana Communities Advancing Recovery Efforts and LGBTQ+ Care. The teleconferencing model, known as Extension for Community Healthcare Outcomes (ECHO), are free, virtual hubs that help local health providers build greater capacity to treat addiction-related health problems by connecting them with area experts and others in their fields.

So far, more than 4,000 participants from throughout the state and neighboring states have participated in the hubs.

On campus, IU also has created a certificate and master’s track in addictions counseling and an online certificate that will help students entering the mental health professions recognize and respond to addiction. A research-based group counseling program for college-aged people who identify as being in recovery for a substance use disorder was also launched.

Moving forward

Throughout the past three years, our researchers have brought an expertise and drive unmatched by others, Newhouse said. As another crisis hit the U.S., she acknowledged that IU researchers responded with the same intensity. 

"When the pandemic hit, our researchers pivoted to continue to provide services and support to one of our country's most vulnerable populations, and they have used their work to study the impact of COVID-19 on those with substance use issues," Newhouse said. "While there is still more work to be done, I am proud of the milestones we have achieved through the Responding to the Addictions Crisis Grand Challenge. We look forward to continuing to work with all of our partners in the fight against this persistent crisis."